Provider Demographics
NPI:1164137105
Name:RECOVERY ROCKS LLC
Entity Type:Organization
Organization Name:RECOVERY ROCKS LLC
Other - Org Name:RECOVERY ROCKS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERLYN
Authorized Official - Middle Name:DANETTE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:208-539-0838
Mailing Address - Street 1:414 N LINCOLN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-2300
Mailing Address - Country:US
Mailing Address - Phone:208-324-5431
Mailing Address - Fax:
Practice Address - Street 1:414 N LINCOLN AVE STE 2
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-2300
Practice Address - Country:US
Practice Address - Phone:208-536-0536
Practice Address - Fax:208-324-5597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty